The proposed application for a K08 Mentored Clinical Scientist Research Career Development Award is being submitted by Donald Chi, a dentist with advanced clinical training in pediatric dentistry and dental public health. Dr. Chi is currently a PhD candidate in Oral Health Services Research at the University of Iowa. This award will allow Dr. Chi to meet his long-term goal of becoming an independently-funded clinician scholar with an interdisciplinary research program that addresses disparities in oral health and access to dental care for children with special health care needs. His immediate career goal is to extend his dissertation research on access to dental care for Medicaid-enrolled children with a chronic condition by developing, testing, and refining a new multi-level conceptual model on access. Dr. Chi proposes the following five aims related to his career development: (1) improve conceptual understanding of access to care for low-income children with special needs; (2) learn and apply new discipline- and theory-based research methods; (3) collect pilot data for a future R01 application; (4) improve writing skills and professional networks; and (5) develop mentorship skills. In addition, he will test the central hypothesis of the proposed research plan - that the health care system-, community-, provider-, family-, and child-level determinants of access to dental care are complex, interrelated, and vary in relative importance depending on type of access being examined - through the following three research aims: (1) identify the multi-level determinants of access to dental care for Medicaid-enrolled children with a chronic condition using administrative data; (2) evaluate the extent to which behavioral factors are associated with access to dental care for Medicaid-enrolled children with a chronic condition using survey data; and (3) assess the relationship between access to dental care and the level of unmet dental need for Medicaid-enrolled children with a chronic condition using clinical data. This research will guide future studies on access and help in the development of multi-level interventions that will improve the oral health of Medicaid-enrolled children with a chronic condition. The proposed career development and research activities will take place in highly supportive, research-intensive environments. Peter Milgrom, DDS and Colleen Huebner, PhD, national experts in their respective fields and Directors of the Northwest Center to Reduce Oral Health Disparities at the University of Washington School of Dentistry, will supervise Dr. Chi's research and career development activities. In addition, Dr. Chi will receive consulting advice from John Neff, MD (co-developer of Clinical Risk Grouping software); Lloyd Mancl, PhD (biostatistician); and Elizabeth Momany, PhD (Iowa Medicaid data expert). Finally, all activities will be overseen by an External Advisory Committee consisting of Jeffrey Murray, MD (Professor of Pediatrics, University of Iowa); Peter Damiano, DDS, MPH (Professor of Preventive and Community Dentistry, University of Iowa); and Diane Martin, PhD (Professor of Health Services, University of Washington). This cross-institutional, interdisciplinary mentorship team will facilitate Dr. Chi's natural progression from current research experiences to the mentored clinical scientist development phase and then to independence. Public Health Relevance: There is a dearth of research on access to dental care for publicly-insured children with special health care needs. This project seeks to identify and understand the multi-level determinants of access to dental care for Medicaid-enrolled children with a chronic condition. Our work will be used to develop clinical and policy strategies designed to reduce oral health disparities and to improve the oral health of these vulnerable children.